AADF  Application for Advanced Training  Form

NOTE:
If You are applying for Basic Auriculotherapy Certification
CLICK HERE

 ACI
PMB 270
8033 Sunset Boulevard
Los Angeles, CA 90046

 

Name:__________________________________  Degree or License:_________________________________
#1
Course, Seminar, Workshop or Conference Title:___________________________________________________
Organization offering Training: _________________________________________________________________
Faculty Name(s):___________________________________________________________________________
Date(s):_____________________________  Location:____________________________________________
Training Objectives:_________________________________________________________________________
________________________________________________________________________________________
#2
Course, Seminar, Workshop or Conference Title:___________________________________________________
Organization offering Training: _________________________________________________________________
Faculty Name(s):___________________________________________________________________________
Date(s):_____________________________  Location:____________________________________________
Training Objectives:_________________________________________________________________________
________________________________________________________________________________________
#3
Course, Seminar, Workshop or Conference Title:___________________________________________________
Organization offering Training: _________________________________________________________________
Faculty Name(s):___________________________________________________________________________
Date(s):_____________________________  Location:____________________________________________
Training Objectives:_________________________________________________________________________
________________________________________________________________________________________

I have successfully completed training listed above. ___________________________________________________
                                                                                                              (signature and date)

 

ACI
PMB 270
8033 Sunset Boulevard
Los Angeles, CA 90046